How To Remove Sticky Bandage From Skin

Combining skill and knowledge ensures safe removal.

Takeaways:

Ameliorate your cognition on how to remove medical tape or wound dressings
Discover products and strategies to ease the tape removal feel for your patients

By Ann-Marie Taroc, MSN, RN, CPN

All nurses accept struggled with removing pressure sensitive adhesives (PSAs)—medical tape, plastic bandages, wound dressings—from fragile skin, next to healing wounds, or from sites of frequent reapplication. For some patients, removal can crusade medical adhesive–related skin injury (MARSI), which presents equally persistent erythema, skin stripping, blisters, or bleeding. (See Who's at risk for MARSI.) And other patients may feel broken-hearted because of previous experiences with painful PSA removal.

Who'southward at risk for MARSI?

Patients with fragile or delicate skin are at risk for medical adhesive–removal pare injury (MARSI). These patients will have a weakened connection between peel layers that may be injured when pressure-sensitive adhesives are removed. Before beginning removal, consider these patient factors:
• Newborns —The connection between the epidermis and dermis is weaker than in adults.
•Older adults—Every bit people age, the pare construction weakens and loosens, resulting in separation of the skin layers upon adhesive removal.
•Medications—Some drugs, such as corticosteroids, tin can crusade thinning of the skin, which increases a patient's risk for MARSI and delayed healing.
•Malnutrition and aridity—Patients who are malnourished or dehydrated may have weakened skin integrity.

Our understanding of PSAs and their removal can help foreclose harm and patient feet. This commodity will await at the qualities of PSA adhesives and backings, explain the principles of removal, and discuss products that aid removal.

PSA adhesives and backing

The skin's surface qualities—wet, hair, oil, and shedding dead cells—brand PSA adhesion challenging. PSAs are designed to overcome these challenges, while balancing successful adherence and piece of cake removal. Both the adhesive side of the PSA as well as its bankroll cloth play a role in adherence and removal.

Adhesive

Acrylate, silicone, and hydrocolloid are iii usually used adhesives. They each work in dissimilar ways. (Run across Comparing adhesives.)

As acrylate adhesive warms, it fills in the skin's rough surfaces. Many medical tapes and some dressings contain acrylate with varying levels of adhesion, making some easier to remove than others. Some strongly adhering acrylates identify patients at risk for MARSI.

Silicone adhesives—found in wound dressings and tape—adhere to the crude surfaces of the skin at initial application. This low-energy connection separates easily from the skin. Because it easily detaches, silicone PSAs aren't appropriate when adhesion is critical, such every bit when securing an endotracheal tube.

The adhesion of hydrocolloid products increases with fourth dimension, creating the same level of risk for MARSI as a well-adhered acrylate. Detachment requires a combination of manipulating the PSA bankroll and dissolving the adhesive.

Comparing adhesives

Bankroll

PSA backing materials also affect removal. To separate the PSA adhesive from the skin, we have to misconstrue the bankroll by stretching or pulling. The challenge with stretching, still, is our ability to maintain directional control. In the presence of hair, a wound, or a catheter, nosotros don't want to cause discomfort, distortion, or dislodgment. Consequently, the removal procedure we select includes assessing both the adhesive and backing of the PSA equally well equally the presence of any object we don't desire to disturb.

Principles of PSA removal

Yous take ii options for PSA removal: low and slow or distortion. With low and dull, pull back the PSA at a depression horizontal angle, away from the corner or edge, separating information technology from the skin. Distortion requires stretching the PSA backing to shear the adhesive from the skin. However, PSA removal is more than selecting 1 of ii procedures; it requires understanding the core principle of supporting the peel while correctly detaching the product.

Skin is a soft and flexible organ that moves and bends in the management nosotros pull. Pulling off a PSA at a vertical angle creates the greatest force, simply it may hurt peel and distort a healing incision. Consequently, you must support the skin with your hands past anchoring the agglutinative on the dressing (when stretching) or the newly exposed peel (when peeling dorsum). A depression angle of skin requires less force to dissever adhesive from skin, which you accomplish with either process by keeping the PSA low and close to the surface. The goal is to avoid MARSI by minimizing the corporeality of strength needed for detachment.

Agglutinative-removal products

Silicone-based adhesive-removal products are the best selection for aiding PSA removal. They evaporate, leave no residue on the skin, and are not noted for causing dry skin. If y'all don't have access to silicone-based products, other options include water, booze, or emollients. Understanding the pros and cons of each will help you cull the right solution.

Water may be hands attainable, but it can weaken water-permeable PSA backings, separating them from the adhesive simply not affecting its connection to the skin, leaving backside a mucilaginous residue. Alcohol, on its own or combined with an antiseptic similar chlorhexidine, can solubilize an adhesive, making it easier to detach. However, alcohol evaporation causes vasoconstriction and dries the pare. In dissimilarity, emollients, such equally mineral oil or lotions, facilitate separation of adhesive from the skin, causing no harm. Unfortunately, emollients may separate the adhesive from the backing and leave a viscous residual.

To ensure successful use of adhesive-removal products, follow product instructions. For instance, an agglutinative-removal product fabricated with an odorless mineral spirit can finer dissolve the adhesive for pain- and injury-complimentary removal. However, if you don't follow the product instructions to launder off whatsoever remaining product with soap and water, the patient'due south skin may dry and crack.

Removal products aren't appropriate in all cases. For example, they may exist contraindicated in the presence of dermal glue or in close proximity to an incision.

Case study:
Low and tiresome prevents injury
Joe Roberts, a 60-year-old man with type 2 diabetes, is ready for discharge from the infirmary. His nurse, Alice, must offset discontinue his peripheral intravenous (PIV) catheter. Mr. Roberts is eager to exit and asks Alice to bustle.
Alice notes that the cannula is well secured with a transparent polyurethane dressing. Mr. Roberts' skin is dry and loose. During shift handoff, Alice learned that Mr. Roberts has peripheral neuropathy. She understands that removal of the PIV will require noesis and skill to prevent MARSI.
Every bit with removal of whatever PSA, the kickoff edge is the most challenging. Alice chooses to use an adhesive-removal product. Considering transparent polyurethane dressings are water-resistant, Alice applies the removal product liberally, gently detaching a corner of the dressing from the peel. When she has the edge of the dressing in her hand, she pulls information technology dorsum depression and tedious. This technique gives Alice greater control and allows her to keep applying adhesive remover, while supporting Mr. Roberts' skin. She removes the dressing from the edges toward the catheter, working with the management of hair growth.
When Mr. Roberts grows impatient with the slow progress, Alice takes the opportunity for patient instruction, explaining that her approach to removing the PSA will prevent a skin wound that may exist deadening to heal considering of his diabetes.

Case report:
Alleviating patient anxiety
9-twelvemonth-sometime Emily Greyness arrives in the emergency department for evaluation of a head laceration. Earlier assessment can brainstorm, David, the emergency section nurse, must remove a big plastic bandage from Emily's forehead. Emily fearfully anticipates its removal.David recognizes that the acrylate adhesive foam-backed bandage, placed an hour agone, may non take adhered well to the skin. However, he realizes that sharing this logic may practise zip to alleviate Emily'south feet.To make sure removal of the bandage goes equally smoothly as possible, David decides to use a removal aid. He chooses balm because he doesn't have admission to products specifically designed for agglutinative removal. With patience and slow removal, he eases the bandage off. David then cleanses the skin to remove any remaining lotion. This pain-free bandage removal may help Emily feel less anxious about similar situations in the future.

Combine knowledge and skill

PSA removal is a combination of skill and knowledge. No unmarried solution fits every patient or care environs, and then understanding the qualities of various PSAs, the principles of removal, and the pros and cons of removal products helps ensure condom removal.

Ann-Marie Taroc is a staff nurse at Seattle Children'southward Hospital in Seattle, Washington.

Selected references

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Matsumura H, Ahmatjan N, Ida Y, Imai R, Wanatabe G. A model for quantitative evaluation of skin harm at adhesive wound dressing removal. Int Wound J. 2022;10(3):291-4.

Matsumura H, Imai R, Ahmatjan N, et al. Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: Comparison of eight different adhesive wound dressings. Int Wound J. 2022;11(1):50-iv.

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Reevell G, Anders T, Morgan T. Improving patients' experience of dressing removal in exercise. J Community Nurs. 2022;30(5):44-9.

Salmanoğlu M, Önem Y. Diabetic foot: Even the almost innocent may turn into a threat. Euro J Gen Med. 2022;11(2):117-eight.

Taroc A. Staying out of viscous situations: How to choose the right tape for your patient. Wound Care Advisor. 2022;iv(half-dozen):21-half dozen.

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A guide for adhesive removal: Principles, practice, and products